 Q: What are the treatment options?
A: The first step is to have a physical exam. For patients with varicose veins, doctors can perform a specialized scan called a venous Du¬plex scan to analyze the “plumbing” of the pa¬tient’s leg veins and determine whether the valves are leaking.
Spider veins are often treated with sclero¬therapy, which involves injecting medication into the veins via small needles, radiofrequency (which often goes by the name of Veinwave or Veingogh) or lasers. Several types of lasers are used to treat spider veins on the legs; however, sclerotherapy usually has a higher success rate. There is a recently FDA-approved medication called Asclera (polidocanol) which I prefer to use for sclerotherapy. It has Novocain-like anesthetic qualities, so it numbs as you use it, and it has a very low incidence of side effects.
For the large, bulging varicose veins, there are severalnew treatment optionsavailable as alternatives totraditional vein stripping, a procedure inwhich the diseased portion of the vein is removed and the vein is then tied off, or ligated.
 These alternatives do not have the lengthy downtime, scarring, and pain associated with traditional vein stripping. All of these procedures can be done in the office, and you are up and walking immediately afterward.
Some of these alternatives include:
Echo-guided foam sclerother¬apy. This is an outpatient procedure that usually takes only 30 minutes. It involves using ultrasound guidance while injecting foam made from air mixed with a medication. The foam makes the medication more effective while making it safer at the same time.
VNUS Closure. This is a mini¬mally invasive procedure that uses a radiofrequency catheter to shrink the veins. It takes about an hour to do, and it currently has about a 99 percent success rate.
ELVeS procedure (also known as EVLT or EVLA). This uses a very small laser fiber to shrink the veins. ELVeS is a third-generation laser that causes much less pain and bruising than the older lasers that some still use for varicose vein treatment. It also uses a very small diameter laser fiber, so it can bend and treat areas that other lasers cannot. Like the VNUS Closure, ELVeS has about a 99 percent success rate, and it can be used to treat some vessels that VNUS and some other lasers cannot.
Most insurance companies cover the VNUS Clo¬sure and the ELVeS procedure and patients are generally allowed to return to work in 1-2 days with either treatment.
Veins, like the heart and arteries, are an integral part of the circulatory system. And while varicose and spider veins can pose a health problem for many people, with appropriate medical care and treatment the health and the appearance of the legs can be improved.
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